Objective:The characteristics of general information,clinical manifestations,laboratory data and imaging data of patients with ANCA-associated vasculitis(ANCA)-associated vasculitis(AAV)complicated with Interstitial lung disease(ILD)were retrospectively analyzed in order to help clinicians to improve their awareness of the diagnosis of the disease and reduce missed diagnosis and misdiagnosis.Methods:A total of 200 inpatients diagnosed with AAV in a third-class first-class hospital in Jilin University from January 2012 to May 2022 were recruited.According to whether patients had ILD patients were divided into AAV with ILD group(AAV+ILD group)and AAV without ILD group(AAV-ILD group).The general information,clinical manifestations and laboratory tests of patients between the two groups were compared and the initial manifestations,imaging data and blood gas analysis results of patients in AAV+ILD group were analyzed.In addition,the clinical characteristics of patients in the AAV+ILD group with ILD as the initial presentation and the AAV+ILD group with nephritis as the initial presentation were compared according to the initial presentation.SPSS 26.0 statistical software was used for statistical analysis.Results:1.The median age of 77 patients in the AAV+ILD group was 67 years old,and the median duration of disease(from the first symptom to the diagnosis)was 3 months,including 42 males(54.5%),35 females(45.5%),and 30 smokers(39.0%).The median age of patients in AAV+ILD group was higher than that in AAV-ILD group,the proportion of patients with smoking history was higher than that in AAV-ILD group,and the median duration of disease was longer than that in AAV-ILD group.The difference between AAV+ILD group and AAV-ILD group in age,smoking history and duration of disease was statistically significant(P<0.05).2.The clinical manifestations of 77 patients in AAV+ILD group were cough and expectoration in 66 cases(85.7%),dyspnea in 53 cases(66.8%),fever in 33 cases(42.9%),fatigue in 18 cases(23.4%),weight loss in 17 cases(22.1%),hemoptysis in14 cases(18.2%),clubbing finger in 1 case(1.3%),and Velcro in 60 cases(77.9%).Compared with AAV-ILD group,patients in AAV+ILD group had a higher incidence of cough,expectoration,dyspnea and Velcro Rales,but the incidence of fatigue in AAV+ILD group is lower than that in AAV-ILD group.There were significant difference in cough,expectoration,dyspnea,fatigue and auscultation Velcro Rales between AAV+ILD group and AAV-ILD group is statistically significant(P<0.05).3.Compared with the laboratory test data of AAV+ILD group and AAV-ILD group,there was no significant difference in white blood cell(WBC)count,erythrocyte sedimentation rate(ESR),Ig G and complement C3 levels(P>0.05).Compared with AAV-ILD group,the levels of hemoglobin(Hb)and lymphocyte(LYM)count in AAV+ILD group were higher,and the levels of C-reactive protein(CRP),complement C4,and creatinine(Cr)were lower,the difference was statistically significant(P<0.05).4.The positive rate of MPO-ANCA in AAV+ILD group was high,and the positive rate of PR3-ANCA was low.There was a significant difference between AAV+ILD group and AAV-ILD group(P<0.05).In MPO-ANCA+ILD group,ground-glass opacities and cystic opacities were dominant,and UIP pattern was dominant.5.Patients in AAV+ILD group were divided into MPO-ANCA+ILD group and PR3-ANCA+ILD group according to ANCA serotype.There were differences in age,smoking history,sex and time of disease between the two subgroups,but the differences were not statistically significant(P>0.05);There were differences between the two subgroups in clinical manifestations: cough,expectoration,hemoptysis,fever,fatigue,weight loss,dyspnea,clubbing fingers,and auscultation of Velcro Rales,but the above differences were not statistically significant(P>0.05).There were differences between the two subgroups in laboratory indicators: WBC count,Hb content,LYM count,ESR,Ig G,C3,C4,Cr levels,but the above differences were not statistically significant(P>0.05),but the CRP level of patients in MPO-ANCA+ILD group was lower,and the difference was statistically significant(P<0.05).There were differences in imaging findings between the two subgroups including ground-glass shadow,cystic shadow,spotted shadow,grid shadow,strip shadow,honeycomb shadow and nodular shadow,but the differences were not statistically significant(P>0.05).There were differences in blood gas analysis values between the two subgroups,but the differences were not statistically significant(P>0.05).6.Eighteen patients with AAV + ILD presenting with nephritis(NEP)at first onset(NEP-AAV + ILD group)were compared with 55 patients with AAV + ILD presenting with ILD at first onset(ILD-AAV + ILD group).1)Compared with NEP-AAV+ILD group,the ILD-AAV+ILD Group had a higher average age,a higher proportion of males,more smokers,and a longer duration of disease,but the above differences are not statistically significant(P>0.05);2)The patients with ILD-AAV+ILD group had a higher rate of cough,expectoration,dyspnea and Velcro Rales,and the difference was statistically significant(P<0.05);the patients with ILD-AAV+ILD group had a higher rate of fever and clubbing fingers,but the difference was not statistically significant(P>0.05);the patients in NEP-AAV+ILD group had a higher rate of hemoptysis,fatigue,and weight loss,but the difference was not statistically significant(P>0.05);3)The WBC count,Hb content and LYM count of patients in ILD-AAV+ILD group were higher,and the difference of the above indexes was statistically significant(P<0.05);Compared with ILD-AAV+ILD group,patients in NEP-AAV+ILD group had faster ESR,higher CRP,higher C4 level and higher Cr level,and the difference of Cr level was statistically significant(P<0.05);4)The positive rate of MPO-ANCA and PR3-ANCA in NEP-AAV+ILD group was higher than that in ILD-AAV+ILD group.The difference between NEP-AAV+ILD group and ILD-AAV+ILD group was not statistically significant(P>0.05).MPOANCA was the most common serotype of vasculitis in NEP-AAV+ILD group and ILDAAV+ILD group;5)Comparing the imaging manifestations of patients in NEP-AAV+ILD group and ILD-AAV+ILD group,we found that there were differences in ground glass shadow,cystic shadow,spotted shadow,grid shadow,strip shadow,honeycomb shadow and nodular shadow between the two groups,but only strip shadow had statistical significance(P<0.05),and the other differences were not statistically significant(P>0.05).Among the 18 patients in the NEP-AAV+ILD group,9 showed UIP mode(50.0%)and 8 showed NSIP mode(44.4%);Among the 55 patients in the ILD-AAV+ILD group,33 showed UIP mode(60.0%)and 14 showed NSIP mode(25.5%).Among the patients with AAV and ILD with ILD as the first manifestation,UIP mode was the main manifestation of lung imaging.Conclusion:1.Compared with AAV patients without ILD,AAV patients with ILD have a high proportion of men and smokers;2.In AAV patients with ILD,the positive rate of MPO-ANCA is higher,and the primary manifestation is lung symptoms(mainly ILD);while the imaging manifestations of MPO-ANCA+ILD group were mainly in UIP mode;3.In AAV patients,when ILD is the first manifestation,the WBC count,Hb content,and LYM count of AAV combined with ILD increase significantly;the UIP pattern is the main imaging manifestation of their lungs. |